Agrobacterium radiobacter Endophthalmitis Associated with Baerveldt Tube Exposure

<i>Agrobacterium radiobacter</i> is a Gram-negative bacillus and a rare cause of endophthalmitis. An 85-year-male presented with late-onset endophthalmitis associated with exposure of an inferonasal Baerveldt tube. The patient was initially treated with anterior chamber paracentesis and intravitreal antibiotics. Aqueous humor culture revealed <i>A. radiobacter</i> resistant to cefazolin, ceftazidime, amikacin, tobramycin, and trimethoprim-sulfamethoxazole. Subsequently, the patient underwent explantation of the glaucoma drainage implant (GDI). After initial improvement, the patient had clinical worsening and was diagnosed with recurrence. Subsequent treatment involved explantation of the second GDI in addition to pars plana vitrectomy with silicone oil infusion, intraocular lens removal, and administration of intravitreal antibiotics. Visual acuity improved but remained at count fingers at 2 weeks. This is the first reported patient with <i>A. radiobacter</i> endophthalmitis associated with an exposed GDI. This report illustrates the resistant nature of this organism in addition to the efficacy of silicone oil administration and intraocular prosthesis explantation.

Baerveldt-XEN persistent proximal occlusion: solving new problems with old answers

A 51-year-old woman was referred with uncontrolled intraocular pressure (IOP) despite maximal medical IOP-lowering therapy. Her background included several failed glaucoma filtering surgeries, including aqueous drainage devices. Considering the need to perform surgery in a patient with both scarred conjunctiva and corneal endothelial deficiency, a surgical technique combining cornea-friendly XEN stent connected to a large-plate Baerveldt glaucoma implant was undertaken. Unfortunately, XEN implants obstructed twice during the early postoperative period. As further XEN replacements were unfeasible, there was the need to bridge the gap between the Baerveldt tube and the anterior chamber. An easy accessible, cheap 22G angiocatheter segment was used for this purpose. With a follow-up of 6 months, there were no postoperative complications nor loss of efficiency, with IOP of 7 mmHg. Tube extension using angiocatheter is a viable, cost-effective option in these difficult cases, saving the surgeon from having to explant and replace the entire implant.

Baerveldt shunt surgery versus combined Baerveldt shunt and phacoemulsification: a prospective comparative study

AimTo examine the efficacy and safety of Baerveldt tube (BT) implantation compared with combined phacoemulsification and Baerveldt tube (PBT) implantation in patients with refractory glaucoma.MethodsSeventy-six eyes of 76 patients were enrolled, 38 pseudophakic eyes underwent BT implantation alone and 38 phakic eyes underwent the BT implantation combined with phacoemulsification. Groups were matched for preoperative intraocular pressure (IOP) and number of glaucoma medications. Preoperative and postoperative measures recorded included patient demographics, visual acuity (VA), IOP, number of antiglaucoma medications and all complications. Patients were followed up for a minimum of 36 months. Failure was defined as: inadequate IOP control (IOP≤5 mm Hg/>21 mm Hg/<20% reduction from baseline, reoperation for glaucoma, loss of light perception vision, or removal of the implant).ResultsThere was a significant difference in failure rates between groups at 36 months (PBT 37% vs BT 15%, P=0.02). There was no significant difference for PBT versus BT in preoperative baseline ocular characteristics. At 36 months: median IOP=14 mm Hg vs 12 mm Hg, P=0.04; mean number of antiglaucomatous medications=1.7 vs 1.3, P=0.61; median VA=0.8 vs 0.7, P=0.44. Postoperative complication rates were similar in both groups (n=5 vs 5; 13% vs 13%).ConclusionsFailure rates were significantly greater in the PBT group at 3 years. Median IOP was also significantly higher in the PBT group. These results suggest that combining phacoemulsification with aqueous shunt surgery may have a negative effect on long-term shunt bleb survival.

Hyaluronidase injection for improved tissue dissection in Baerveldt tube surgery

Purpose: To describe a novel technique for tissue dissection during Baerveldt tube surgery. Methods: We present a technique for posterior dissection of conjunctiva and Tenon tissue for the placement of a glaucoma drainage device. Hyaluronidase is used in the early stages of surgery in order to minimize tissue trauma and facilitate easy dissection even through existing adhesions and conjunctival scarring. Results: The technique facilitates convenient dissection through tissues. We did not experience any intraoperative or postoperative complications. Conclusions: The described technique has substantial advantages for Baerveldt tube surgery, specifically in cases of previous ocular surgery and subsequent conjunctival scarring. It is safe and easy to perform, and should be considered in cases of glaucoma drainage device implantation surgeries.